Profession football is the most popular sport in the US. This popularity is growing despite increasing publicity over the impact of concussions and the potential for long term health consequences of the game. Neurosurgery is the specialty that has always been devoted to the diagnosis and treatment of all sports-related concussions. Our specialty has been leaders in the scientific and clinical research on this crucial public safety concern in addition to driving policy and organizing national and international programs for prevention through Think First.
Recently, the Los Angeles Times reported on a high profile study that directly tested the value of preventing concussions by 10 widely used helmets casting a long shadow on current designs. Unfortunately, there is no commercially available concussion-proof football helmet. One could be designed very quickly that would meet the standard (of preventing concussions) but would have the unfortunate complication of creating a large number of cervical spine injuries. The authors correctly challenge the National Operating Committee for Standards In Athletic Equipment (NOCSAE) standard as not being protective against concussive type blows. The test standard was developed (anvil drop) to prevent catastrophic device failure, skull fracture, subdural hematoma, and death. This standard drove the manufacturers toward the shell helmet that is used today. There are substantial opportunities for improvement in this design using contemporary mechanical engineering principles and materials sciences.
It is crucial to remember, however, that in addition to helmet design, there are many other factors that must be considered including helmet fit, proper conditioning of the athlete, proper coaching, and rigorous enforcement of the rules.
One very important and exciting area of research is gaining a better understanding of the impact of rotational acceleration. This year the NFL has validated three accelerometer devices in two independent laboratories and performed the first on field pilot study. Over 11,000 impacts were measured in this small pilot. Hopefully improvement in these devices, particularly in the rotational analysis, will allow a better appreciation for the types of impacts that result in clinical concussions.
Neurosurgeons also want to emphasize a critcal lesson which must be learned from motor sports, downsizing an adult helmet to fit a child does not in fact impart optimal protection. This is another concern of neurosurgery advocacy, approached directly with close dialogue with NOCSAE.
Given the rising popularity of the game, improving player safety, for the youngest to the professional football player is a complicated and challenging undertaking, but is one that must be given priority. Organized neurosurgery remains at the cutting edge on many fronts on this issue:
- Improving our understanding of sports-related head injury
- Collaborating on equipment design and testing
- Supporting high value prevention and public awareness programs
- Insuring standards in the evaluation, treatment and return to play of those sustaining concussions
Neurosurgeons are where you need them: Upfront on concussion, helping to keep brains healthy.